CIHM 
Microfiche 
Series 
(Monographs) 


iCMH 

Collection  de 
microfiches 
(monographies) 


Canadiiin  Institute  for  Historical  Microreproductions  /  Instltut  canadlen  de  niicroroproductions  historiques 


^lOOQ 


Tech'  ical  and  Bibliographic  Notes  /  Notes  techniques  et  bibliographiques 


The  Instifutp 


lompled  to  obtain  the  best  oriomal 


copy  availa,^'! "  %•'  t'lining.  Features  of  this  copy  which 
may  be  bib' :.  aphic?!'/  unique,  which  may  alter  any  of 
the  Image:.  ^  'he  foproducticn,  or  which  may 
significantly  cnc.r'ge  :r;p  usuai  method  of  filming  are 
checked  below. 


Coloured  covers  / 
Couverture  de  couleur 


I — ^  c 

□    Covers  damaged  / 
Couverture  endom 


magee 


□    Covers  restored  and/or  laminated  / 
Couverture  restauree  et/ou  pelliculee 

I I    Cover  title  missing  /  Le  titre  de  couverture  manque 

I J    Coloured  maps  /  Cartes  geographiques  en  couleur 

I      I    Coloured  ink  (i.e.  other  than  blue  or  black)  / 


n 


D 


D 


Encre  de  couleur  (i.e.  autre  que  bleue  ou  noire) 

Coloured  plates  and/or  illustrations  / 
Planches  etVou  illustrations  en  couleur 


Bound  with  other  material  / 
Relie  avec  d'autres  documents 

Only  edition  available  / 
Seule  edition  disponible 

Tight  binding  may  cause  shadows  or  distortion  along 
interior  margin  /  La  reliure  serree  peut  causer  de 
I'ombre  ou  de  la  distorsion  le  long  de  la  marge 
interieure. 

Blank  leaves  added  during  restorations  may  appear 
within  the  text.  Whenever  possible,  these  have  been 
omitted  from  filming  /  II  se  peut  que  certaines  pages 
blanches  ajoutees  lors  d'une  restauration 
apparaissent  dans  le  texte.  mais,  lorsque  cela  etait 
possible,  ces  pages  n'ont  pas  ete  filmees. 

Additional  comments  / 
Commentaires  supplcmentaires: 


L'Institut  a  rnicrofilme  le  meilleur  exemplaire  qu'il  lui  a 
ete  possible  de  se  procurer  Les  details  de  cet  exem- 
plaire qui  sont  peut-etre  uniques  du  point  de  vue  bibli- 
ographique,  qui  peuvent  modifier  une  image  reproduite, 
ou  qui  peuvent  exiger  une  modification  dans  la  metho- 
de  normale  de  filmage  sont  indiques  ci-dessous. 


LJ 


] 


Coloured  pages  /  Pages  de  couleur 

Pages  damaged  /  Pages  endommagees 

Pages  restored  and/or  laminated  / 
Pages  restaurees  et/ou  pelliculees 


□    Pages  discoloured,  stained  or  foxed  / 
Pages  decolorees,  tachetees  ou  piquees 

I  Pages  detached  /  Pages  detachees 

■   t    Showlhrough /Transpar 


uence 


j       I    Quality  of  print  varies  / 

1 ^    Qualite  inegale  de  I'impression 

□    Includes  supplementary  matenal  / 
Comprend  du  materiel  supplementaire 


Pages  wholly  or  pahially  obscured  by  errata  slips, 
tissues,  etc.,  have  been  refilmed  to  ensure  the  best 
possible  image  /  Les  pages  totalement  ou 
parliellement  obscurcies  par  un  feuillet  d'errata,  une 
pelure,  etc.,  ont  ete  filmees  a  nouveau  de  fa^on  a 
obtenir  la  meilleure  image  possible. 

Opposing  pages  with  varying  colouration  or 
discolourations  are  filmed  twice  to  ensure  the  best 
possible  image  /  Les  pages  s'opposant  ayant  des 
colorations  v.Tnables  ou  des  decolorations  sont 
filmees  deux  fois  afin  d'obtenir  la  meilleure  image 
possible. 


This  Item  is  filmed  at  the  reduction  ratio  checked  below  / 

Pn  rinriifnoni  net  #ilr» 


I  t .,,.»  ^» 


10x 


14x 


18x 


12x 


16X 


20x 


22x 

26x 

30x 

1 

24x 


28x 


32x 


The  copy  filmed  here  has  been  reproduced  thanks 
TO  the  generosity  of: 

J.J.    Talman  Regional    Collection, 
D.B.    Weldon  Library, 
University  of  Western  Ontario 

The  images  appearing  here  are  the  best  quality 
possible  considering  the  condition  and  leg'biliry 
of  the  original  copy  and  in  keeping  with  the 
filming  contract  specificationa. 


Original  copies  in  printed  paper  covers  are  filmed 
beginning  with  the  front  cover  and  ending  on 
the  last  page  with  a  printed  or  illustrated  impree- 
sion,  or  the  back  cover  when  appropriate.  All 
other  original  copies  are  filmed  beginning  on  the 
first  page  with  a  printed  or  illustrated  impres- 
sion, and  ending  on  the  last  page  with  a  printed 
or  illustrated  impression. 


The  last  recorded  frame  on  each  microfiche 
shall  contain  the  symbol  — ^  (meaning    ■CON- 
TINUED"), or  the  symbol  V  (meaning  "END"), 
whichever  applies. 

Maps,  plates,  charts,  etc.,  may  be  filmed  at 
different  reduction  ratios.  Those  too  large  to  be 
entirely  included  in  one  exposure  are  filmed 
beginning  in  the  upper  left  hand  corner,  left  to 
right  and  top  to  bottom,  as  many  frames  as 
required.  The  following  diagrams  illustrate  the 
method: 


L'exemplairc  film6  fut  reproduit  grace  d  la 
g6n6rosa6  de: 

J.J.    Talman  Regional    Collection, 
D.B.    Weldon  Library, 
University  of  Western  Ontario 

Les  images  suivantes  ont  ♦it*  reproduites  avec  le 
plus  grand  soin,  compte  tenu  de  la  condition  et 
de  la  nertet*  de  I'exemplaire  film*,  et  en 
conformit*  avec  les  conditions  du  contrat  de 
filmage. 

Les  exemplaires  originaux  dont  la  couverture  en 
papier  est  imprimie  sont  f.lmAs  en  commencant 
par  le  premier  plat  et  en  terminant  soit  par  la 
derniAr-  .age  qui  comporte  une  empreinte 
d  impre»jion  ou  d'illustration.  soit  par  le  second 
plat,  selon  le  cas,  Tous  les  autres  exemplaires 
origmaux  sont  film4s  en  commenpant  par  I3 
premiere  page  qui  compone  une  smpreinte 
o'impression  ou  d'illustration  et  en  termi.-.ant  par 
la  derniire  page  qui  comporte  une  telle 
empreinte. 

Un  dee  symboles  suivants  apparaitra  sur  la 
derniira  image  de  chaque  microfiche,  selon  le 
cas:  le  symbole  — «i-  signifie  "A  SUIVRE"    le 
symbole  V  signifie  "FIN". 

Les  cartes,  planches,  tableaux,  etc..  peuvent  etre 
filmis  d  des  taux  de  reduction  diff^rents. 
Lorsque  le  document  est  trop  grand  pour  etre 
reproduit  en  un  seul  clich*.  il  est  film*  d  partir 
de  I'angle  supirieur  gauche,  de  gauche  d  droite, 
et  de  haut  en  bas.  en  prenant  le  nombre 
d'images  nicessaire.  Les  diagrammes  suivantr 
illustrent  ia  m*thode. 


1 

2 

3 

1 


MICROCOPY    RESC.UTION    TEST    CHART 
ANSI  and  ISO  TEST  CHART  No    1 


1.0    ? 


I.I 


||jj  2.2 

ijZO 

II  1.8 


1.25    III  1.4 


1.6 


^     /1PPLIED  IMHGE     inc 


A  Simple  Method  for  Determining  Vari- 
ations in  the  Hydrogen-Ion  Con- 
centration of  the  Blood 


K'.      I.      I.  I    \    N  ,      \l    1>  . 

I        (  ,^      \<  I  i\\   X    I    K  I.  I,      \l    i) 

\  -.  I  ■ 

W       M  .    K  I  M     M    \  U  k  M  M    I  .     ,\l    D 

i;  \i.i  I  \i<H;r 


l\,l'iiiii,it  /I, 'III  till-  .h.hii.s  iij  hili-iiiiil  Midiiiiw 


J-    ^ 


rni(  A(io 

\\nPii  \\     \lniHM     AsWH-IATIOX 

I  iM     Ml  M'Ki  i»  AM'  'liiiKi  vl''i\i-    VnnTM   l>iAmi"i<N    'iHiir 


A  Simple  Method  for  Determining  Variations  in 
the  Hydrogen-!on  Concentration  of 
the  Blood 


K       I,      I.  i    \    \  .      \1    l>  . 
I..     (,       i<  '  '  W    \    !    K  I,  I-..      M    I' 

Wii 

\\       \1  .    K  1  M      M    \  K  U  I  '  '  T   I  ,     M    n. 


A  siMi'i.i-:  Mi;iiini)  i-(  )k  i)i:ii;i<Mixi.\(i  xariahoxs  i.\ 

■rill-:  ini)R(  )(,i:x-i(  )X  Cfixticx  ru  atk  ix  oi' 

■nil-:  r,i.(  x  )i)* 


K     I.     !.1AA',     Ml),     I..    (,.     RoWXTRI-.l-:.     M.D. 

AMI 

W       \l.  KIM     M  ARRK  iTT.     \l  !) 

Ilnm.'.ii  lildiid,  a^  it  L'\i~l>  in  tht-  imkIv.  i^  faiiilly  alkaline  in  I'L-aciKMi: 
that  i^,  it  lia^  a  li\  ilr(mn-iMn  cdnci.'nlratica;  unly  slitjlitly  k>^  than  l!iat 
III'  piiri.-  walLT,  and  this  licyrce  df  alkalinil\-  lend-  to  he  maintained  even 
when  eiin>idcrahle  (|nantitie>  (it  aiid  are  iruduecd  wilhiii  the  hudy,  or 
are  intrndiu'ed  liiini  willuiut. 

Ill  a  n.Iati\e  iiicrea-e  in  the  acid  eiintent  of  the  hodv.  the  term 
"aiidn-i-"  i-  a|i]ilied.  Acidn-i-.  euneeixalih'.  nia\  he  hroiijjht  ahont  in 
iilher  way-  th.in  thu-e  ]il-t  nienlinned  -idr  eNample.  liv  deerea-ed 
exereliiin  (if  acid  or  h\'  In--  uf  ha-e-  from  the  hody.  Ihe  eundition 
ha-  heeii  reei  lyni/ed  in  a  \arietv  nf  wav-,  -tieh  a-  inerea-e  in  the 
anminnia  enertieient  nf  the  nrine,  deerea-e  nf  earhiui  dinvid  ten-inn  in 
llie  ahenlar  air.  ihe  liiidinL;  nf  ahnnnnal  arid-  in  the  hlnnd  and  urine. 
\iv  inere.'i-ed  alkali  tnler.anee  and  li\'  diniiin-lu'd  titrat.ahle  alkalinit\'  nf 
the  hlnnd  -ernni.  li\-  i-hani;e-  in  the  hentni^lnhin  di--iieiatinn  eiir\e  and 
liy  aelii.il  dele  rniinalion  nf  the  hydi'nueii-inn  enneentralinn  nf  the  lilnnd. 
i  'rndiietinn  nt  anminnia.  low  erint,'  nf  earhnn  dinxid  ten. -inn  in  the  aheo- 
l.ir  .lir  and  in  the  hlnnd.  and  exeielinn  nf  acid-  are  all  ii.ari  nf  the 
i-iini|ien-atnry  nieeham-ni  nf  tin-  Imdy,  and  it  i-  nnl\-  when  thi> 
nieih,ini-ni  hemnie-  ii\ertaMil  that  aiipreekahle  change-  in  the  lixdrn- 
L,in-inn  eniuenlr.atiiin  nf  the  hlnnd  neem-.  The  haind  il-elf,  nwiiii,' 
'  hiell\  in  the  "hnrfer"  aetinii  nf  the  earhniiale-  nf  ihc  pla-ma  and 
]ihn-]ihate-  nf  the  enriiii-ele.-.  can  i.ake  iiji  enn-iderahle  anmiinl-  ni 
aiid  nr  al'^.ili  witlmnt  nuich  eliani,'e  in  it-  re.ielinn.  It  i-  [irineiiialh 
due  tn  the  wnik  nf  1..  |.  1  lendei'-i m'  and  hi-  eiillahnratnr-  that  we 
h.ive  a  ele.ir  ennee|iliiin  nf  the  mnde  nf  .lelinn  nf  lhe-e  "ImtVer-."  .\n 
aiipreeiahle  ehant^e  in  the  h\-drnt;en  ion  eniuenlration  nf  the  hlnoil 
iiidieatcs  a  laihire  of  the  iirnteeti\e  meeh,nh-ni  ,ind  the  iire-t'iue  of  a 
-ii;nilieant  acido-i-.  i  lerein  lie-  the  peitiliar  \alne  nf  a  delirminatinn 
of  the  hvdrni^ren-inn  eoneeiitratinn  nf   the  hlnnd. 


"■  l-'i  im   the    IV'ilnitnc   ami    Mr.lKal   Clinios.   Juliii-    lln|)kiiis   Hospiial 
1.  For  a    lull   i!isci!--Mii.   -.  r    llemlcrson,   L.    I.;     I'.rgebn.   d.   Plivsiol.,   1909 
viii.  298. 


A  liriff  wnrd  cif  i-\|ilaii:ilinn  nKi>  lie  kim"  '"i'  tlbisr  un:k-i'n-li mu'l  ici  the 
physii-iii-luinical  imtlioils  of  cxprcs-iiiH  tlic  reaction  nt  a  sdhnicii.  A  -dmii.ti 
is  acid  when  it  e<.ntaiiis  an  (xccss  «i  hyilrogin  nvcT  hydrnxxl  ion-,  neutral 
when  hydrogen  and  hydroxy!  ion*  are  in  e(inal  ninnlier-.  and  alkaline  when 
hydroxy!  ions  predominate.  An  acii!  of  "tinrinal"  strenm!i  eonlain-.  in  one  liter, 
a  gram  of  hydroyen  oap.ililt  mi  furnnng  !iyc!roi;en  inn-.'  an(!  its  strength  may 
!ie  ex])res-eil  as  1  X,  Diinliny  -uih  a  -oliition  tin  tnni-,  ue  W(jnld  have  1/10 
.\  or  a  solntioti  containing  l/lD  gram  of  actual  or  potential  liyilrogeii  ions  to 
the  liter.  Continuing  the  proce--  of  dilution  until  l/IIMKKl.(«lil  normal  acid  is 
obtained,  we  wmild  have  in  such  a  solution  I/1II,'KHI(XI0  gr.nn  <•(  hydrogen  ions. 
Pure  water,  however,  di-sociatcs  to  form  hydrogen  ;uid  h>drci\.\I  ion-,  and  at 
31  C  contains  approximately  l/IO.OiHl.fXKI  gram  .if  h\drogcn  ions  to  the  liter 
and  an  ccpiivalent  amoimt  of  hydroxvl  ion-  1  that  :-.  17  gm.i.  That  i-  to  say, 
pure  water,  our  stanilard  of  neutrality,  i-  l/lll,ll(KMKK)  X  acid  anil  also 
l/UVKKUHHI  X  alkaline.  To  .-.void  writing  large  lignres  it  i-  customary  to  use 
the  logarithmic  notati(jn  and  to  express  1/10,01H).(M1I)  X  a-  lO'X  or,  tnorc  con- 
veniently, as  suggested  liy  Soren-en,'  to  ilrop  the  ID  and  miini-  sign  and  say' 
pH7.  If  we  h.-ive  K--  than  l/Ill,il(H1,PtK)  gram  of  hydrogen  ion-  to  the  liter,  the 
-olution  is  less  acid  than  water,  that  is,  it  is  alkaliiie  —  so.  pi  IS  nuans  actually 
l/l,00n.0()()  X  alkali.  The  higher  the  exponent  the  ni'ire  .ilkalinc.  or  what  is 
-aying  the  -aine  thing,  the  K-s  acid  is  the  solution 

To  -mn  np  ; 

pill  =  X/lll  aciil. 


pn6  =  X/!.lKl(Mll'(i  acid. 

pi  17  =  xi-rrh-.u.iry. 

,,||S  —   X/l.oiKl.tHIII  alk:ili. 


,,1114  =  X    III  alkali. 


The  rcactimi  m'  tlu-  MikpiI  -cr'im  \,'irii>  .•i|.]iriiNiiiialc!\  licU\ccil 
III  17  ,-iii(l  pi  Is.  ilic  iH'iilr.-il  |inint,  |.II7  hciiiL;  rc:n'ln'il  (Uilx  in  -cxcrc- 
iiticoiniicii-atcij  acidd-i-.  :nnl  ,'i  rca.-liim  of  ]<\\X  liciiii;-  attainoil  |icrhaii- 
Miil\   ;i  ftcr  ailmini-lration  I  ii  alk.alii-. 

TIh'  tin  .1-11  roll  lent  nf  the  |il  I  m'  llic  lilooil  a-  i-(iiii]'an.'ii  w  illi  that  '>i 
innri^aiiic  -nlmiini-  ina'-ciil  -  iii.anv  ciiltk-ullic-.     'I'ln.'  -tainkaril  t,';,,  ihaiii 

cU'iirnniclric   nictlaul   lia-   liccii  aiplicl   to  llic  M 1   li\    a    mimlicr  ni' 

iin  c-'.i^.atur-.     A  mil  rr\  irw  of  tlic  lilrratiiro  tip  In  I'Mi'  ?-  tn  lie  imniil 
ill  at!  .article  li\    l'.iii,a//i        .Mure  ri  .1  lU  iKicrniiii.itioii-  li:i\c  ln-cii  iii.adc 


2.  For    the    -;ikc    of    -iinplicily    wc    will    cou-idcr    here    nnly    a    "-Irnry'    acid 
ami  a.ssumc  it  to  he  completely  ionized  in  dilute  solution. 
,?.  Soreiisen  :     I'.rgelm.   d.   Physiol.,   \'\2.  xii.  401, 

4.  C1I7  and  (11*)  ^  7  arc  synonymous  expressions.  Intermediate  values,  as, 
for  example,  lietween  pi  17  an<l  pH8,  arc  commonly  expresscil  in  one  of  two 
ways,  as  0.25  X  10'  or  pll  =  76.  The  latter  method  is  used  in  this  paper 
The  conversion  of  one  exnression  into  the  other  i-  simple.  For  1  xample.  log. 
0.25  =  —  0,602,  then  025  X  10  '  =  10"  ""  x  11''  "  ~  10 '""  -r  pll  -  7,502. 

5.  Bota//i  :  I  )er  Ham  -owie  die  uhrigeii  .\u--cheidnng(n  rnd  Ki  1  prrllussig- 
keiteli.  edited   liv   ('     Xeul  erg,    Berlin.    I''l  1 


li.-  1  la^vlh.iKh  ami  I .umlsijaanl,''  lViii>,'   IValc  >  ul  Milroy.''    The 

r(.--uli~  iia\f  nut  inni  alici;,'filKT  iinif<irm,  am.  tl-c  accuracy  of  the 
inuhnd  a^  apiilicil  to  Mood  i~  (Hic-tioiiaMc  on  accuunl  oi'  tlic  necessary 
reduction  ol  tin  i,.  liio^IdKin.  and  ilic  inthicncc  oi'  the  I'rotein  -nh-tances 
lire~ent. 

Hie  lacl  that  the  ■,'a-  chain  n.ethod  ,,i  delerniinini,'  the  ]i\]  ni  the 
hlood  rec|uire>  a  delicate  and  e\|ienM\e  I'iece  of  |ih\ -icocheniical  apjia- 
ratti-  a.^  well  ti-  idn-iderahle  technical  trainint;  ha-  heeii  -tandint;  in 
the  way  of  clinical  investigation-  of  acido-i,  ihrecth  from  the  -ide  of 
the  hlood,  an<l  ha-  led  to  the  very  \aluahle  hut  indirect  method-  of 
apiiroach,  -nch  a-  tli(.-e  titilized  in  die  -tudie-  of  Sellard.-,'"  I'almcr 
and  1  leiuler-.m''  and  Adier  and  i'.lake.'- 


vxi  xciri.i;  oi--  i  m:  m  irudii 
Meretn'nre  the  imlicator  nietlKMJ  lia-  nut  ], roved  of  f,'reat  \aluc  in 
the  -tiidie-  of  llvdro;,r^„.jlJn  concentration  of  the  hlund,  althon,L,di  tlic 
reaction  (jf  inor-anic  -oltttion-  may  he  determined  (|uite  acctirately  hy 
till-  mean-.'  DilTerenl  indicator-  -liow  their  <-olor  chan-e-  at  \aryin<,' 
det^ree-  of  hydr<ii,'en-ion  concentration;  lor  exaniole,  the  color  of 
methyl  oran-e  clian-e  from  pink  to  yellow  a-  the  ]d  1  of  it-  -,,lution 
chan^'es  from  .i  to  .-.  At  interme.'iate  iioint-.  \arious  coloi  -  may  he 
ohtained  and  a  certain  color  indicate-  a  delinite  pi  1.  >innlarl\ .  jiheiioh 
lihthalein  .hani;e-  fn  m  colorle--  to  pink  lielween  |.liS  and  idllM  and 
can  he  tl-ed  for  the  mea-tirenient  of  ||-ion  concentrations  hetweeii 
these  two  point-.  In  carryin.^  out  the  indicat.n-  method,  it  is  necessary 
to  have  a  -erie-  of  -tandard  -ohnion-  ,,f  knoM,  ,dl  and  an  imlicator 
exliihitin.tj;  ea-ily  distinpii-hahte  color  chan-es  at  liylrotren-ion  con- 
centration- apiiro.\imatin,t,'  that  of  the  -olutioii  un.ler  coii-ideralion.  It 
IS  then  -imply  neces-ary  to  add  e(ni  d  amoiir.t-  of  indicator  to  the  -tand- 
ard  solutiuiis  tmd  to  the  solution  heint;  te-ted  and  to  determine  which 
of  the  colors  in  the  standard  scilution-  mcj-t  closely  iiiatche-  that  of  the 
unknown  -olution. 


jjaanl :     Uiid..   1'<IJ,  xli.  24/. 

7.    P>I,is:     Physinl.   Soc.    I'rnc ,   Jamiarv,    V44 

S.   PcalHHJy.   I'.  W.:    Sni.lic-  on  .\c„lusi-  ami   Dyspnea  in   Renal  an.)   Canliac 
l)i<caso,    lin;  .Xm.nivi-  Int.  Mi.i,  .  ici4    ^iv,  _'.?fi. 

''    Milroy;     (Jiiart.  .hmr.    Kxpt-r.    I'liy-inl,    I<,14,   Mii,    U|. 

in.   Sellard, :    Johns  Hopkins  llosp    pull.,  I'.IJ,  xxi.i,  2S'/;  il,i,|     pJU   xxv    IDl 

II.   Palmer,    WW.,   ami    Hcn.lerson,    L.   J;     Clinical    St.i.lies   on    Acid    Base 

i-..|nililirmm  and  the  Natnro  of  Aeidosi^,  Tin,  .\i;c  mivfs  I.nt    Mid    19n   xii    \S3 

\2.  A.ller,  H.  M.,  a,  d  Ulake.  Gerald:     I  lie  detention  nf  Alkali  i,v  the 'Kidney 

wnh   special   Reference  tn   Acidosis,   Tm    .\k.  nivis   Int.    Mi-:i,.,   loi],   vii    479 

l.r   For  a  fnll  description  of  the  application  of  mduators  to  thi-  nnriio-e    see 
SC,ren-en:     l-rL-.rlm    d     Pliy.;,,l.    !':!.\   xi,.  ,-!9,l 


'Ihi-  111' lliM,l  li:.-  liron  -iu>i  "  lullv  u-v>^  on  llic  iiriiic  l.v  llcnder- 
~c.ii"  au'l  !i\-  \\  al]inlr,'  \-  prnUiii-  iiUrrlirc  w  illi  tiio  lulor-  dl"  in:iii> 
indic.itnr-,  ainl  :i-  l»iili  Mii'nl  and  -iriiiii  |i(i-~f~-  mlur,  ii  lias  lici-ii 
iiii|ii."iMr  In  apl'lv  lln'  imili",!  ilirctlv    m  \\w  l.lon.l  '" 

It  -iiiiKd  |.rol>aliK'  that  lln'  iiidiiaiMt-  nullu"!  iiii'^lit  l.o  utili/cl  inr 
lilon.l,   |iru\i.R'd   laili.riiiL,'   iiiatUT-   and    iirolrin-   muld   In'   rxrhnlrd   li\' 

iiu'aii-    nf    dial\-is,'       It    1.1 1    1-    dia.|ii.cd    int..    riilli.iinii    -acs    and 

dialv/id  l"'ir  I'lxr  iiiinnU'-.  llir  dialy-aU  i-  irvv  traini  prnt^in  ami  K-i<\,,r- 
itiU  nialln-.  lull  i-untains  -all-,  and  i>  uvll  aijai'Iid  In  tlic  u-c  nl  indi- 
i-atnr-. 

>in.\'  iilu'iii'l-nlpliniu  phlliaKin  rxlnliil-  .Iri'iniU'  \arialinii~  in  cuialil) 
III'  i-i)luf,  with  \ir\  innnitc  dilinciUH-  in  liu:;-ci'^rii  ion  i-muHiitfatinn 
lulwri-n  ii||ii4  and  S-1,  il   wa-  adniiliM  a-  iIk'  iiidiralcr  in  ilii-  iiU'llmd 

TKI  l'\i;  \l  I'lN  (II.  slANDAHl)  CULdKS 

Staiiilnnl  phospli^itc  mixiim-  arc  prc|>ariil  ai-conliiifr  to  Si.riMiscn'-"  dircc- 
lioiis  a>  follows : 

1/15  null,  acid  or  primary  potasMum  |)lio<pIialc.  5.078  Kram?  of  tlio  pure 
rccryi^talli?ed  salt  (KILPO.)  is  dissoIv<d  in  freshly  distilled  water  and  made 
up  to  1   liter. 

1/15  tiiol.  alkaline  or  seconilar\'  '^odiiim  pliospliate.  The  pure  reery^tallized 
>alt  (  Na.llPO. .  UH:0)  i-^  exposed  to  the  air  for  from  ten  da;  s  to  two  weeks, 
protected  from  dil*t.  Ten  molecules  of  water  of  crystallirntion  are  Riven  off 
and  a  salt  of  the  forninla  Na  1 1 PO.  Jl  1  ()  is  obtained :  11X76  grams  of  this 
is  dissolved  in  freshly  distilled  walir  ml  r'n<le  np  to  1  liter.  Tic  solution 
■honlil  Ki\e  a  deep  rose  re<l  color  with  plien.  idillialeiii.  If  onU  a  faint  iiiiik 
color  is  olilained,  the  salt  is  not  snlVicienlly  pure. 

The  soUitiors  .in  iiiivid  in  the  iiroporlions  irdicaled  lulow  to  olitain  llie 
desired  id  I  ; 


I  11 


-   s-n  ji  o   k  4 


rrimiiry  I'nm.   Pho« 


73     i>3     "it 


HI     ft  «  i:i.'.' 11  "   ■».»»   •>'>   :t  ■-'    -.» 


Srpoitiliiry  SimHiiiii    l'Ii*t«  . 


.  s    ;:!    TT    «i    siijfl.Rmi.flnI.f  !H.4n(l.»l».n 


Tlinc  I.e.  (if  c:u-h  ni  tin-  snhitintis  ;iR'  pl.-n-rd  in  -iiit.aMf  small  Ifst 
Ittlii's  (  PX)        1(»  mm  .  iiisiili'  inca-iirciiicnl  i      l'"i\o  dn>]is  oi  an  aiitlcous 


14  Henderson:    Biocheni.  Zl«chr.  I'iin.  xxiv.  40. 

15  Walpolc:    Riochcin    Jour..  1910.  v,  207. 

10  S.iren-en  ( Ilioehfni.  Zt'chr .  I'.W.  .xxii,  2.W>  has  applied  the  indicator 
method  to  the  fdlralc  ohiained  after  precipilalinif  lilooil  or  scrum  liy  hoilinR 
Hith  three  volume*  of  dilute  h>drochlnric  acid.  Adier  ( .\m  Jour  Physiol, 
1M17,  XIX.  1)  has  tested  the  reaction  of  the  serum  with  paper  dyed  pink  with 
rosoiic  acid.     The  ohjeiiions  to  thr-e  methods  arc  ohviou«, 

17.  Preliminary  exp»>rimenls  showed  that  it  was  impo«sil.le.  hv  the  iii<licator 
method,  to  rilitain  cnncorilant  re»ull>  on  dilutions  of  scrum 

IS    s,   ,.,,...,,       |ii,„.h,.-ii     7t-i-hr.    inno,    xxii.   .>52 


n.ni  per  ocnt.  -dluiidii  of  iilioiiol-iilplioiic]ilitlialciii  arc  addcil  tii  each 
tube.  i  he  Idi),-  arc  scaled  (ilV.  '1  lie  veries  of  color,-,  reprc-eiuiiii,' 
ihllcrcnt  'uncciitralion.-  of  h\(lrin;cn  ion-,  con-lituli-  the  -taiidard-  lor 
comiiari-on  of  color  in  carrviiii,;  mu  ihc  ilclcrniination.''' 

I'KI.I'AKA  I  K  p.\    Ol-    SACS 

One  oiiiicc  uf  ccllniiiin  lAmliMii>  -  ncf;,ui\<-  i-.iitniir"  is  .lis-olvcd  in  51K1  c.c. 
"t  a  mixture  o:  f(jiial  quantities  of  ether  and  clli\l  ;iKi.Ih.].  The  solid  swells 
tip  and  dissolves  with  occasional  gentle  shakings,  in  forty-eight  hours.  As  .-, 
-ninll  amount  of  liv.nwi  s,.,|i,„,.,n  separates  out  at  first,  the  solution  -lionl.l 
stand  tor  at  last  thrci-  or  four  ilays,  after  which  the  clear  ■-uperiiatant  -oluiiou 
is  rcaily  for  use."'  A  small  test  tube  (13!  by  <)  nnn,  inside  measurcnknt  i  i- 
filled  vilh  this  mixture,  inverted,  and  half  the  contents  jionred  out.  The  tuhi- 
I-  then  riehi.d,  and  the  collodion  allowed  to  fdl  the  lower  half  again.  .\  -ec.nid 
time  It  is  iiuirteil  anrl  rotated  on  its  vertical  asi-.  ihe  collo,li,,ii  Ining  draincil 
oil.  Care  mii~l  Ik-  l.d<iii  to  rotate  the  tuhe,  in  .loUr  lo  -ecur'  a  uniform  thick 
ness  througlioul  Tlu  tiilic  i-  clamped  in  llu  iii\eited  position  and  allowed 
to  stand  for  ten  nniiiue-.  until  tin-  odor  of  elher  finally  disappears.  It  is  fdled 
five  or  six  limes  »itli  c.  1,1  wattr.  or  it  is  alloweil  to  soak  live  minutes  in  cold 
water.  .\  knife  Made  is  run  around  the  upper  rim,  .so  as  to  loosen  the  sac 
from  the  rim  of  the  te-l  tube,  and  a  few  culiic  centimeters  of  w-iler  are  run 
down  between  the  s,i,-  ,-„„|  tin-  ^|nss  of  the  tulie.  liy  gentle  pulling  the  tube 
is  ixtracted,  after  which  it  i-  pre-erved  by  complete  immersion  in  water." 


Iili     >\l 


'III  ii  i\    is;;ii  I  \   -iiir   MI  riinii 


I  lie   hloo.l   or    -inini   i-  di.ilwcil   agalii-t   an  D.S   per  cem    -odmni 
chlorid    -Mhitiin], 

I'.efore  applying  the  test,  it  is  neces-ary  to  ascertain  that  the  s.dution  is  free 
from  acids  other  than  carbonic.  To  dcleriiiine  this,  a  few  cubic  centimeters 
of  tlic  salt  solution  are  placed  in  a  Jena  test  Inbc  ami  one  or  two  drops  of  the 
iiulicator  addeil,  whereupon  a  yellow  color  appears.  Ou  boilinK.  carbon  dioxid 
is  expelleil,  ami  the  solution  loses  its  lemon  color  and  takes  on  a  slightly  brown- 
i-li  tint.  Ill  llie  absence  of  this  change,  other  acids  arc  present,  and  the  salt 
solution  i>  ilurefore  not  suitable'  If.  on  the  other  han.l,  on  achling  the  itxli- 
cator,  pink  at  once  appears,  the  sobition  is  alkaline  and  hence  cannot  be  used 


I  I  (    II  MC    '    I      M  M  111  111 


i  in    hihiiic  can  he  c.inud  mil   on  iiihrr   miiiiii.  pl.iMii.i.  whole  or 

deliliriii.itcd  hi I       llu   woik  nm  i  he  done  in  ,,  i ii  free  frmii     ;iiu 

tit  aciiK  ol  ,iiiiiiioiii,i. 


\'i.  The  colors  may  fade  slightlv  in  a  month's  lime,  but  mav  s|il|  be  used  for 
>ompari»on  if  less  indicator  iii  added  to  the  ••unknown"  solinic.n,  as  Ihc  color 
i|iiality  remains  the  same. 

.11.  Obtained  from  the  .\n«co  Co.,  Minghamlon,  \  V  Thi*  contains  ,10  per 
cent,  of  water  and  mu»l  be  riii>^e(l  with  absolute  alcohol  before  lieinK  <li.ssolved 
for  use. 

JI.  Belter  sacs  are  olilained  from  solutions  llial  have  been  allowi-!  '•.  ■...,.•• 
in   well  stoppered   bottles   for   from  two  lo  three   weeks. 

22.  .Sacs  that  have  dried  became  brittle  and  impervious. 

J.V  It  is  advi«ahle  tn  kfcp  the  salt  solution  in  a  Jrna  glass  (la.k  and  to  pro- 
tect it  from  acids  in  thi  air  by  iiicdiis  of  u  s.h1«  time  mbe. 


8 

<  iiie  li.  ihixi.'  i',<',  (il  ck'.-ir  siTuiu-'  or  el  Mik"!  i-  run,  In  nicanv  (if  :i 
Miliit  ]iinnk'il  |ii]>ti.  inlo  a  ilialy/ini,'  -ac  wliirh  ha-  \k\\\  wa-ln.l  in-iilc 
aiiil  (lUl-i'li'  wiih  -alt  -nir.tiun  ami  wliicli  l  -  ln-ni  K--U''l  I'nr  Ital>-  liv 
lillinu  Willi  ll.c  -alt  -nhiiioii  -  Tin'  -ar  i-  lnwcri'il  iiiln  a  -mall  tc-t 
tiili'--  I  liiii  l'\'  |!i  iimi  .  iii-idc  iiKa-umiRiil- I  I'lur.aiiniiL;  .^  v'a'.  '>\  tlu- 
-•ail  -dlMlinii.  until  tlif  lltii.l  (.11  tlu-  nut-iilc  dt'  tin-  -ar  1-  a-  liiL;li  a-  nii 
till'  in-i'K'.  Itiiiii  !ur  tn  uii  niniuti-  arr  allnwi^l  I'l.r  cliaK -is,^''  \'\\v 
(.(illiiiliii-i  -ar  i-  rniiiiwil  ami  '  ilfnp-  ni  tin-  iuili(-aliiv  are  llii  ifnUi^liK' 
uiisnl  with  tlk'  ilial\-atr  Tlir  inlir  i-  ilu'ii  n  aiii  lavi'd  with  the-  -ri'ic^ 
I'l  -lamlafd-  until  tlir  rniTv-|H  .n.lmo  ii.lnr  i-  t'liiiial.  whii-li  inilicali.'^ 
llu'  h\clniL;rn-i(in  n  nu  inlralii  m  |. result   in   tlir  iliah-ati\ 

I  In -I  tr-t-  It,  r  Imu  lan'inl  nut  with  .^  r  r,  nl"  I.Iii.hI  nr  -rruiu 
I  llr  -allir  l\'-ttll  -  atT  ulitainr.l  \\itli  1  r  ..■,  nt'  IiImihI  i,r  -rnitn  1  in  tin- 
iii-iiU"  nl  tin-  -ac.  ami  with  tin-  ■inmunt  ii  1-  iininatrrial  whrtlur  tluTi- 

i-    1    nr  .>   I'  I-     lit'    -all    -nlntlnll    nil    llu'   nllt-iiU' 

inMrAKlMi.N     III      II    1:1.^     Willi     M\\ti\K|lS 

i  nr  llii-.  a  yiiiiil  lii^lu  1  natiual  1  n-  aitilii  iai  1  ami  a  wliitf  harkj^'rouiul 
at'.'  ri'i|iu'-ili'-..  ivvailiiii;-  niii-t  lu  iiiadr  iiiiuuilialiK  I  Ik-  iuIh-  uialrli- 
illg-'  mil-!  rlii-il\  i~  viK-.liil  ami  aln  llu  lulu-  mi  nllur  -.iiK-  ,,f  it. 
Tlicsi-  an-  iritiiallx  iii-|.r(lril  a,i;ain-t  a  wliilo  hacki^niun.l.  (  hani^im,' 
the  oriUr  ui   tlu-  iiiln-  ntun  uiaki-^  ililYi-n-iu-i--  umri'  a]i|iarvni.  " 


1  "N  I  1:1 1|  ^  I  II     III  1:    Ml   I  Ih  III 

l\i  pcati-il  ilii]i|uatr  ilitiriinnatiiiM-  nu  llu-  -aim  -aiii|ilr-  nt"  lilnml 
:inil  III  -(-nitn  liaM-  miu  inrc-il  u-  that  tlu-  limit  -  1  il  i  imr  avi  \  i  r\  -lii^hl  : 
tnr  i-\aiuiiK-.  iIk-  M-niin  linin  a  ra-c  nl"  milij  ai-uln-i-  1  u-hil;  i|nantili(.-v 
nl  -iriiin  \;iryitiij  frnm  1  in  .^  >■  r.  -.iid  clialv/iiis^  inv  irnm  Iim-  in 
liltcfti  minnti'-- )  ii'.iw  llu-  tolluwiiij;  series  of  ri-ailmy^:  7^'',  7.5^.  7.?^, 
7.^^,  7.(),  7.!'!',  7.55.  7.r'5.  7:<^,  7.rr^  Tin-  dN.-il.-iioil  whnjc  h],»»\  frinii 
the  same  case  ^ave  llu-  follnwiii^;  reailiii;,'^  iimkr  similar  c(milili()H> : 


7.2^,  7.2r.  7  2?.  7.2r.  7  2.  7  25.  7.2h.  7.S.  7.2^, 


/Jr.  /dr.  /  _'," 


24.  Ilmmljvis  ttniN  in  iiiirc;i«-  llu-  aiiility  nnil  inii«t  be  avoiilcil. 

2l<  .\  --ac  may  In-  w-vd  mure  lli.iii  (im-i-  fur  Mcnini.  proviili-il  it  i«  thnri)iiKlily 
«;i'lu-il. 

J(i.  Thi-  alkali  lily  nf  llu-  ilialyiatr  im-ri-asc  rnpiillv  iliititiK  llu-  lir->i  live  miti- 
iilf*  Tlu-rc  i-»  iiii  ,-i|iiiri-i-ialilr  chaim,-  iturinc  llif  next  t>-ii  miiiillcs.  I'r(ilcin<i 
may  ni.i'kr  thi-ir  a|i|ii-iiranic  in  tin-  <lial>-att-  in  from  ti-n  In  Iwonty  niin-itrii. 

27  h  mn«t  Ik-  Iiornj-  in  niiml  thai  nnr  i«  lit-rr  m.-ilrliinii  thi-  qnatiii.  ..f  i-nlnr 
am!  not  inttn«ily  a-*  in  nnlinary  (-iilnrjiiu-lry. 

-H.  .\  (i-ilnr  talliiiB  l«-t«(-i-ti  two  of  tin  'tandanU  may  lie  reail.  Iiy  int(-rt><>la- 
lion,  111  aniillicr  lit-iimal  place.  \o  effort  was  e\er  maile  to  reail  elo«er  than 
0.05.  I'ttplicatr  c'eterniinalioM-i  »hfinM  lie  made  in  all  i-a«e«  ulirn  «nlVu-ient 
matrfia!  :s  ftvailaMc. 


Ill  or(l<r  tn  tc~l  cmi  iIr.  rlUvt  ui  i1k'  \ -riatidii-  i,,  the  -ac-  ii-i'.i.  a 
minihrr  <.i  .Ktrrniiiialinii-  wrrv  iiia.ic  ..„  iIr.  .,„,k-  .ample  ui  .mini 
""'■  'li^'  l'"ll"\vino-  iTMih.;  (ir.liiiau  lliiii  sic.  7 .7  \  lliick  ^ar.  7  7; 
"|'a(itu;.  invytilav  -ao.  7  7;  .ir.lnian  ihiii  -ac.  7(.-;  \tT\  ihi.k  sir.  77 
A  .iTK'-  Ml  six  iinrmal  -cnim.  wire  run  thn.unli.  ,^  cm-,  ami  1  rr,  |Hir 
tM.n.  ln-ini;  UmM  lor  .lial\M.  In  iwrv  in-lanrr  i.knl'ual  rea.liim.  uiiv 
itl.taiiK'cl 

M'PIJi    M  hi\     ,,]■     till       Ml  Til,, I, 

llaMni;   llin-   a^iuvl  .iiiVMKr.   ,,i    ihr  arciirarv    m1    liie  m,  tlm,!.  ,-, 

^'''■"■~  "'   ''' '-   '''■""!  ""nnal  an.  I  pallml,  ,o„-  ,-a-i-  uvrr  Mu.liol,  willi 

llir     mI1,,\\  111-   IT. nil-  : 

1  \.>vuu,l  nuliriiliials:  i\'.un>  li\r  cases.  ( ,/ )  Srrniii;  Tv>rn!\- 
Iniir  ,,t  \\w  l«rnl\  fur  ,;i.es  R;al  Ivlunn  7'.  ail.l  7S  !,i  ,„k. 
m-laiue,  7  "  I-  iTiunled  : 


pll 

7.(> 

7.fi5 

".7 

7.75 

7.S 


Cases 
4 


' '' '    \\  li"l>    lil'iu.l   I  ,.\;il,ali-,|      I  ;  iinu-Utn  iKHTiinn.alK.n. 
ri';i(i  lilt  x\  lAii  7  )  .iml  7  'i : 


I'll 
7  4 
7.45 
7.5 

7  55 

7 ', 


llif  -!i-litl\  ,i;rralir,ui,li;\   ,,|   vvl,,,)^.  1,| |  .,,  ,,„n|,,,r>,l  willi  .rniiii 

lia-  l„rn  nv,  .i.Mii/iM  li\  ,ilin,,-i  ,,1|  nm -ln;,i!,  .r.  ni  llii.  Iu|,l.  an, I  aii|.i';ir. 
'"  '"  ''"'■  '•'  ''i'  '•I'-l  lii.il  li.in,,-l,,l„n.  an.l  r.|,r,  i,,||v  .  is',  l,riii.ii,'l,.l,in. 
Iii'liavi's  as  a  wrak  .n  ni 

I  el  I)i-til.riii,itc,|  111 1      I  .,,-lv   1,1  iiii.  ,,,„,.^.  ,,,  i|„.  „,„.|^    .kiiknii 

•''"'  ''' I   "•'-   ''""I   "1  pa'alUl    H-nr-  unli  .irimi  ainl  (.\.,l,,h,l   >,\1|,,U 

l«l.«.il.  h  ua-  liimi,!  ih.il  111  -iiKT.il.  ill,  I,  Mill,  uihk.l  1,,  ,,,iia.|„„i,i 
to  thdsf  nlitaiiu,!  vMili  ihr  \\  Imlr  Mi.,  „  i.  km  ih,  i.in-r.ii  \.iii,iti.,n  w.i- 
rallu-r  wi.lo:  ir,,„i  7  I  i,,  7S  .\,,  .„|,|,i„„mI  mhn  uliImh  ua.  nlilaiiinl, 
atid    the    (li'lil,iiii.i!i,.n    in.  n'l>     .crvcl    i,,    i-..tti|.lualc    the    pni.wlunv 

llcikf  it  \va.  ,kri,k.l  In  .il,aii<|nii  Hr.  ,i.f  ,,f  (kiil.rinato.l  1.1 1  in  the 

Milisi()iicnl  niiirsc  of  the  invcstiRntinn 

2.  MLurlliiiu-oiis  iiinUivl  cnsi-s.  In  ur.jer  t.i  iletennine  «lietlur  the 
h.vdroRcii-ioii  ediuxntratiuii  ..f  tlie  l,l„n(|  varies  from  the  iinriiial  in 
disfasc,  a  rnllier  larye  \ariely  nf  eiiii.liiii.ii.  was  .tii,h.(|      siyu   ihi,, 

2"   Tlu-  l.I.-.ul  »v«»  .•..ll.r,.-,!  ,:„  !utH-  .....niiMnifK  a  littlf  ,lrv  ftowtlcfctl  .odiJH. 
oxal;ili-   (lr»i    Iroin  iiirli<>iial<->. 


10 

ikUTiiiinatidii-  wcro  iiiink'  in  r2  ra-i'-.  ciiiiijiri^iiin  the  tcilliiwiiiy  omi- 
ilitinn^:  iirplirili^  (  acutr  aiiil  >linmK').  !_'  i.a~i.'~;  dialuli--  iiRllitu-,  S 
ra^c- ;  nivdcanlial  iii~ulliciiiK\ .  5  i-aM'- ;  ^\pliili>.  4  la^o :  ilirunii- 
arthrili-,  .^  la^i.- :  iivrnicimi-.  aiuniia.  J  i'a~i'~;  ni'urd-c-,  ,^  ra-v-.  ami  1 
ca-c  cai'li  111'  |i\(.liiiv.  i,niii\ciiia,  carciin'ina  ui  mrk,  luniunin  .id-. 
tyjijiiiiil  irxrr.  |iiR'iiiiiiniia.  iiK'niiijidt'iiciu^  im'iiins,'ili-,  1ii1)i.T(.-u1ihi- 
nkninyiti-.  iln 'lrlithia-i~  i  laiiiiilicc  ) .  ]iiilini  Miar\  iiKiiia,  >  (.Tcln  a!  Iriii- 
c'rrliai;i'  uniiiai.  tiilnritikni-  |)lrnri-\.  i'imiI  ami  nidiilli  ili-i.a--r,  aiii^in- 
lU'linitir  <'(K'iiia  am!  l.raiii  Itiinur. 

I  Ik   rr-iill  -  wriX'  a-  Idllnw-  : 

I  (M  >iruin;  ~i\t\  ilim-  i!','lriaiiiiiaiii  .;i-  Si\l\  dl'  i1r'  -i\i\-  ilircL' 
ik'li'iniinati.ni-  iwad  lictwa'in  7.iiaml  7^f<: 

1.1 1  Ca-cs 

7.6  ,  14 

7.65   .  4 

7.7     I'l 

7.75   1 

7  S  22 

I  Ik  lliri.1.'  csii  |iliiiii~  mil  .  uiiniiL;  wiiliin  lln'^r  liiiiil-  unc: 

I  1  I     \r  iii-l.aiKc  d|"  iraiinialir  maita  i-i-  \v  illi  a  rrailiiK^  i  il'  7  ''       '  _'  i 

.\    Uliriif    Upliiiiil    Willi    a    iTa'liHL;    iil    s.ll        ,  .\  \    ,\    >  a-i.'    ni    rlii-nm. 

iKjiliriti-  \\illi  lRniaUiiK-i~   I'lnni  an  at  lUf  y.i-trif  iiK\r.  wiiu-t    -.riiin 

.ill IT  llif  iran-lii-ii'ii  nf  S,-i  i  ,■.(,■,  nf  1iImi.i1,  1i\   i1k'  ~\  rinL;i   nKlliM,].  i^a\  r 

a  riadiiiL:  "1  7  ' '~. 

{  b  ]  \\  ii.  iKMiiM,!  I  I  i\.il.iud  I  :  lliirlv   llinr  .K  u  rininaliiin~>.  ni'  w  liicli 

lliivl\  mu-  ixad  IhIwitii  7,1  and  7,ii: 

]>il  Case- 

74  I 

7.45  J 

7.5  .  ,  ,    in 
7.55  ,                                                      , , ,     S 

7.6     in 

11k  1\\  1.  t,-Ncc|.tiiiii«  were  inslanocs  ui'  puimKni-  .mcniia  llii  i;i-l 
cnso,  iiiinu'.li.iirK  In!!.  i\\  111!,;  n-.m-hi-mn,  L;a\r  a  la'.idiiiL;  ''i'  7  7  mii  tlir 
whok"  liliicMJ.  lln-  1u  ini;  idrnlhal  Willi  lli.il  nii  ihe  ~c  i  inn  ll  '-  nl 
interest  in  iiile  llial  lul'.ia  ir.iii-in-iMn  llir  le.idiiR;-  nn  llir  -iiiiin  .uid 
ulinic  liluiid  Were  al-d  llie  ^aiiK',  lliat  i~.  7ii  I  la  -criMi.l  <  .i-r  ^a\r  ,i 
reading;  nl  7  '.^  in  lln'  \\  linU'  Mdnd.  ilii-  .ii^.iin  In  lU'.,;  nUiiiii  ,d  \\  nli  ilia  I 
on  the  •>! mill 

^.  .huliisis.  I'l-diii  the  jireeediii^;  |-.ar,ijir,i|4i^  it  i-  eMileiit  that  the 
liy'lr(ii;eii-i(i!i  eoiieeiitiatidii  of  the  whole  hlood  or  seriiiii.  normally 
am!  ill  a  ^reat  \ariet\  ol'  di'^ease  ainditidii-.  i-  Hdi  -nliieet  to  ^reat 
variations  \  smalj  siTie^  of  eases  witli  clinieal  or  lahoratdr\  e\  idenee 
of  aei<lo-i-.  i  or  liotli  i  has  hcen  studied,  the  re^nlts  aiii .earing'  in  Taljie  1. 
i'iftci'll  deterniinalidii-  win    in. id.    ni  iiliIiI   rase- 

'n,  {iftaile'-l  rlinira!  histories  are  a{>p<n<k-i|  at  ih-.-  tiit!  nf  this  ji;ij;rf. 


\ 


11 


TABLH  1. — Acidosis  (Ei(;iit  Casks.  Fikikkn  Di  rKRMiNAiioNs) 


Case 
No. 


Date 


12/.'6/14 


1/  2/15 
1-V  3/14 


l/l.l  15 
l/-'5/15 


1/Jf//15 
1/18/15 


1/19/15 


I     s  1  ,- 


\/ny\s 


H-Ion  Concentration 


Whn!,- 

Si-nim  Uln.  1(1 

(Oxal.) 


7  45 


1/28/15 
2/18/15 

7  s 
7J 

6 

I  22/ 15 

"5 

7 

1/22/15 
1/22/15 

r.4 

7.55 

7  1 


7.1 


7.3 


I  'i;iyiio~i^  :u!.l   Remark^ 


Cmiginitnl  cystic  kidneys;  adlie- 
rciit  pcricarcliuiii ;  myocardial 
in-iifficicncy  :  li  y  d  r  o  t  li  o  rax  ; 
ascites;  nrcinia  ;  'plithalcin.  trace 
in  two  hnurs;  CO.-  tension  of 
alveolar  air.   19.5  mm.   Us;. 

Dull;  <lro\vsy;  'phtlialein.  -till 
iinl>   a  trace  in  two  lioiir>. 

.\ciite  and  clirmiic  nepliriti'^; 
hypertension  :  uremia  ;  'pI't'i'T'cin. 
trace  in  two  hours;  Sellards' 
te*t.  complete  decolorization  on 
evaporatiim. 

I'.chimpsia  ;*  mild  toxemia. 

(•'clamp-ia  ;*  severe  I  n  n  e  m  i  a. 
XII.  nitrogen  in  iiriiie.  IS  jier 
cent. 

Thirty-six  hours  after  lahor ; 
alkali  therapy  ;  iloing  well. 

Sarcoma  of  kidney  and  antrum ; 
acidosis;  sudden  onset  of  aci- 
dosis with  "air  luniRer" :  Sel- 
l.irds'  test,  complete  ilecidoriza- 
tinn  on  evaporation;  .acetone 
and  diacetic  acid  in  nrine. 

.\fter  large  doses  of  alkali;  bet- 
ter ;  Sellard^'  test,  faint  pink 
color  before  complete  evapor- 
ation. 

Mure  alkali:  no  dyspnea. 

Kespirations  asain  deep  .i  ii  d 
ii'ii-y  ;  .acetone  in  urine. 

Recnrreiu  vomiting;  no  fo.id  re- 
tained for  three  days ;  acetone 
and  diacetic  aciil  in  urine. 

.Mimentary  intoxication. 

.\ftir  alkali  therapy;  ilealli  next 
d;i;. 

\ciiti'  and  chronic  nephritis;  my- 
"Cardial  insufTicicncy  (slight^: 
anasarca;  tlyspnea ;  "pl'tl'^'cin. 
.55  per  cent,  in  two  hours ;  ace- 
tone in  nrine 

Much  improved;  CO;  tension  of 
alveolar  air,  4(1.1  mtti.  11k. 


*  We   are   mdehted   to   Dr.  J.   \\liitridg(     William-    for    permission    to    -tudv    ihe-e 
eases  iicctirring  in  his  -ervice. 


i;i\Ni;l.>    l\     nil.     IIMi|;ui,|;.\-|,,\    .  (,\.   IM  |;.M  |,,x    ,,|     Till      111. 

IN      I   MM.KIMl.NT Al.     I  I'.NDI  1  |,,.\s 

An  (.•lldV!  Ii;i~  luTii  ur.ttlv  tn  -ic  if  Miiiilar  rlum.-r^  in  llic  pi  I  1,1  llir 
'iliiii'l  .-nitl  -tviini  VMM  1k'  'lrin..ii--tr:iti-.l  m  I'xprrimml.il  aciiin-i^  in  'li  ^j  ~ 
\nnn,il~  wrrc  inir.-tr.!  iiiira\  (.-inin-l;,-  with  .liluir  li\  .In  hIi1(  .ric  ari.i. 
l'nitn,i,K  ,•]    i\\(i  rxprrnnuit-  aiv  i;urn   in   TaMi--  _'  ami  ,v 

T.\l;[.|-.      _'-!'K,,T(«o,,       ,,r       IC.XIMK'IMI.NT       l-tXlKVM.Xnls        LxjlCTIOX       i,l       S/^        II  W^kuUlLOUK 

Acid  Into  a   Dog»    (1-emalk,   Weight  7.3   Kc.) 


I  line 
11.  111. 


.\nit,   ..1" 

IICI 
Iniii-ti  .1 


1 1    I. '11  t'c.iuH  iiir:ilh.Ti 


>ii  inn 


\\li..K> 

l!ln,,.l 

lOxal.) 


111.. 0,1 

I  Iran  II 

I  )ir(.ctly 

lull)  Sac 


K(.iiiark> 


.5  44  .5  4' 

4.11(1 

4  14 

4.17-4.'.? 

4..'(, 

4.5(1-4.=;). 


.'-'1  5..'ii 

.=;4.^ 


4<i 


7.(1 


■45 


7.4. 
7.4.^ 


■45 


7.45 


7  4 


I'.n  .illiiiit;    i;..rMialK 


\"  .-^iiUial   iliaimc   111   ciiiiiliti.iti. 
r..«ar.l    rii.l    ..|    mirc-li.iii.    rc-pi- 

rati.  II-    -1..U    ail. I    .In]..    14   |ht 

minmi . 
.Marki-il     ".iir     Iiuhlut"  ;     rtsjiira- 

tiiin.'i.    1 1    \<ir    niiniilr  ;    piiUf.   31 

I"    '4;   regular. 
Ki'«I)irations    still    ~1,.\\    l.nt    ^lial- 

l.iwor;    animal     111     iairly     hi.ikI 

I'liiiilitidii. 
\t       5  2ft      vcs|iirali..ii'       11       per 

iiiiniite 
Ktsilcss;   i-tniKKliiiw. 
<  MT  laMc:  no  "air  hiiiiKor" :  Ijintj 

rl.iwii    in    nd    apfiarcMt    <li«coni 

flirt;  rcidvcrid. 


-  Inu.Minii.   nia.l, m  part   int..  .niKnlar.  in  part   Jiii.,   U-k   vein.      Mloo.l    for   .•xaminalinn    witli- 
.Irawn    eitlicr    trnm    jngnlar   »r   Un   wm   uii    ,,pp„sit,.   >i.U-.     HCl   ma.lc  np  in  0.,S  per  cent,   salt 

(II-..M  u  \i.  ni.^i'is.sidx 

ill  iinliT  l<.  iKlcrmiiu-  tlu-  ,1.  iii.il  liv.ln.mn  i..n  .  ..n.inlrati.  .11  n\ 
llic  tiliM.il  a-  it  <xi-i.  in  ilic  l„„ly.  ii  ,,  luvc-siry  llial  nu  a-niviiu  11;- 
l>c  niailc  at  Im.ly  liiiiinTatiiri'  ami  iimUT  llic  carl.i.n  .li..xiii  ir'iMnii 
vsislitit;  ill  ihu  vi>>.i.K  a-  -Imun  ],\  an.il\M-  n\  tlu-  aKc.lar  ait  M.i-l 
III"  till-  jmlilislu'rl  R'siili>  <l(,  mil  luliil  tlu'^i-  lu.,  ri(|iiii(.imiii-  and  iIktc 
fori'  lid  not  nivi-  the  rciutiini.  a-  I  .ninlsf-aanl''  ivxprosis  it.  .s7»i',7/>\v/(ij,. 

Sl-IISII. 


M    Lwt\~u-::it,\ :    Rinihim.  J^i^chr..  m.  \V,.  247. 


1.3 

In  a  ^Hiil>  111'  ari(l(i-i^,  Iiowomt,  iIk'-c  CDii^iilcralinii^  arc  <if  ara- 
ik'inic  rather  lliaii  "f  iliiiiial  iiii]"  irlaiui.-.  ^iiicr  w  r  arc  ccHH-cnK-il  with 
\arialinn-.  in  the  pi  I   rather  than  with  il-  aelual  \a!ite. 

lilt-  more  feeeiit  eli'etrunietrie  niea-iireineiit^  lia\e  heeii  earrieii  n'lt 
at   tile  earhuii   diuxid   leii-imi   existiiii;   in   ihe   aKenlar  air  and   in   niui 
ca-e-  at   n.inii  teini'eratnre   (  IS  C,  ).     Sn  Innu  a~  the  iiiea-iirenieni  ~  are 
niaile   at   a   enii^tant   ten-iuii   (jf  ratimn   dicixid   and   at   a   enn-tam    teiii 
piTalure,  the  re-iilt~  are  iil'  \alue  idr  eiiiniiarali\  e  iiur|iii>e>. 


T.MU.F.    ,^. — Protuciil    ui     I'm"  nimi  nt   2  -  [nth  wi  nnis    Inhxtmn    ,ik    X/2 

I  iMiRuellUiRlC     .'Mill     Imi;     a     i)(i,,     (l-IMALl.     Will, Hi     7     K(..  I 


Time 


,IJ1 


Anil    i.i 

IlLl 
Injecieil 


n   I  I  ft  lull 

liemui. 


.?  ?l  1 

'  n  c  c.  liave 

lirt'll  i  11  - 
leeteil. 

.r.'ii 

1   n   i  ertion 

.  11  .1  e  il; 
1  0  5     c.  c. 

4,(1(1 

have  been 

injected. 

4,(K) 

H-Ion  Concentration 


Serum 


(,'> 


Whole 

r,i 1 

(dxal.) 


Iveiiiark- 


<>.'> 


6') 


Seniiii   IihIu   1  elli'W  .  elea: 


l;i.i;iiiniiiK  111  linallie  lieepl)  ami 
.-lowly:  heart-  aetion  very 
forceful ;  regular. 

"Air  huiifjer"  marked ;  respira- 
tion-, 28  [ler  miiiiiie.  I  lean- 
action  foreetiil  :  regular;  -i  rum 
.•illows  moilerale  amount  of 
heniolysi-. 


In  oNlrcmi-;  ga-pinK  for  hreath  ; 
heart  still  Keating  -irotigly; 
-eriini  -how-  marked  henioly-is. 

("ea-ed  lirLatliiug;  heart  stopped 
heating;  artiticial  re-piration 
and  intravennns  injection  of  5 
per  cent,  solution  of  -ndiiii'i 
bicarbonate  unax  ailing. 


111   the  iiietlmd   de-erilu-l   in    thi-   painr,   hi 1    i-  exjin-ed   In  the   .air 

sn  lli,il  the  e,irh.in  dinxid  teii-iiui  i-  l.iw  .  hill  a]'|iarentl\ ,  I'airU  emi- 
-taiil.  Ihe  uhieeliiin  niii^hl  he  iii.ide  that  the  |dl  wmild  lUjiend  nn 
the  .anii.iiiii  lit  eailiiio  d.i..v.i.l  \thieh  h.i-  e-ea."ed  I'riini  the  hlmid  nr 
^eiitni  ihe  inlli  i\\  iiiu  e\|unnieiil-  indie.ite.  Imweu'r,  that  the  pi  I  i- 
iinl  dependent,  within  rea-mialiU-  liniil-,  m;  the  lime  el.ip-iny  helwei'ii 
the  lakniL;  ni  ih,'  hlnnd  ;ind   the  de|etaiiiiiatii>n  d  the  i  IL  iir.i\ided  the 


14 

tuiic  r<mtainini;  l>lo(nl  i>  kcpl  .^luppiTcl  .iii.i  on  icc,  a-  will  be  .-rcn  fruiii 
tliL'  h)ll(j\\  iiii^ ; 

Strum  ()NalatL(l   I'.lood 

ImiiKili.itilv   r  7;  ;  ;; 

After     -"/li,,iir>    7,;5  7  Vi 

Alter  I'*      huur-    7,7?  7  V^ 

\ftiT  _'4       liMi,,-.    775  7'5'; 

ll,  iinutxrr.  hi. mm]  i,  drawn  .iiivrlly  ini,,  a  ~ac  iiiiiin.T-Ccl  in  a  lube 
01  valt  >nitition  and  the  rea.hitL.'  c.^niiiared  witli  ihial  :niiii  the  bldcid 
drawn  aii.l  dclefiniind  in  ihr  11-nal  inaniKr,  -h,-;hi  xarialiun-  arc 
cin-dnnlcred   1 -ec  h".\|nriinent   1) 

l'.>    llinr.,iiL;hly   diakin-  ibe  hi 1  ,.r  -enini  in  liu    ;iir,  il-  ah^ahnitv 

i~  iiUTca-rd.  ThriTl(.iv,  diakin-  ^M.nld.  ni  -rneral,  h.  a'.ni,l,Mh  unk-- 
it  i-  di-ired  id  detrrnnnr  the  |dl  at  a  /(.m  (i  i_  lenMcii,  Such  --UKlii- 
iia\r  hern  carried  ..n  liy    I  )r.   1  ).   \\  .   \\  ih,,n. 

I  be  mlhienee  ni  the  leni|iei-alure  nn  the  readini^-  ba-  been  deter- 
innieih  and  the  re-nU-  appear  in  tijc  aee..iniian_\  ino-  tahiikitidn. 

TMUJ     4.-  \-Ai(iA]iu.\>    ,x    llvimdi.i.x    lux   Cnci  n  tkai  ion    IXa;  to   Cii.iNCks 

IN     TlMPIHATlklC 

\\1"'''    I'.l I  Whole  liloo.l 

li-riiperaunx'  Situni  (iKal.l  Si  riitii  (Oval) 

•^"  ^  ■  "Si  7,5  7N  74 

^'  C.  79  7.05  7.9  745 

I  hi-  elleet  ni  leinperalttre  lia-  hi'en  reen-m/id  In  prexi.in-  worker-. 
''  '-  ^-^i'lenl  ih.al  m  dr.kT  In  nhl.iin  e.  mip.ir.alik'  re-nb-.  teniperaliire 
;-(intn.l  1-  neees-ar>  ,  1  Inr  nie,a-.ni  enieiil-  ha\e  been  ni.ide  lieUveen  '( 1 
an.l  .M  (■ 

■|  he  di:d\-,ile  ..!'  the  hi. km]  ..r  -enini  i-  di-bliy  nii.re  a.i.j  than  lla> 
on-ni.d  ni.itrn.al.  i'  ..ne  .an  nid-e  fr..ni  e\;  eri  n.'iiN  .-.irrie.l  mil  will 
ilihite  MiilniM  hie.irhi.n.iie  -.ilnli.iii-  ei  Mil.ainin;'  e.irhi;ii  .li..\i.l,  .and  pb,,- 
(ibatcs  (if  .ippr.iMin.alely  ihe  pi  I  ;nid  ,-.  ;iu-eiilr,ali,  m  ..i  bl.ni.l.  d'hal 
llie  \.arian..ii  .S  ,1  .■..iiM.anl  ..lie  1111. ler  llie  ,-.  .n.lil  1.  .11-  .,f  llie  nielhii.l  i- 
-'■"""  ''.■'  'li^'  'l''-^'  ■•.i^i-eeinenl  ..f  .hipiieale  .leterniin.ali.  .11-.  ulii.b  b,-;- 
beeii  nierre.l  li.  pia'\i..iid\    in  llii-  j-aper, 

i'.v  .a   e.iiiii  i.len.a-.  the   re-llll-  ..hlaineil    fi.,111   the  .ii,il\-,ile    fnnii   llie 

"ll"!'    ''1 1  ■H"l   ''""111  -enini  e.irre-p..ii,l  \rr\    .l...el\    l.i  lli..-i>  ..hl.iine.l 

.lire.-ll\   by  die  ele.iri.-.al  nielli. i.l  wlun  die  l.iller  ii|.;i-iireiiieiil   1-  in.i.l.' 
•ll   !^  <  ■  ■■ni.l  .11    I  .Mrh.iii  di.i\i.|  ien-i..ii  ni   ti  1  nun    II-, 

I  in-  ai;rt.iiienl  in  re-iilt-  1-  pn.hahly  ,lne  I.,  the  aiil.i-.  mi-ne  eh.ar- 
aeler  .1  the  iw.i  111,1111  -.mree-  .if  >  rr..r  iii\..l\e.|  in  llie  iiielli...!  ..f  dial- 
\  -1-.  naiiul\.  I..--  ni  eafb.in  .li..M.l  ten.lin-  1  ,  oi^j.  hi-her.  tb.il  1-.  nmre 
.ilk.abiU'  le.i.hiiL;-.  an.l  di-pn  .p.  .rii.  nnie  .lial\-i-  ni  .aei.l  an.l  h.a-i,-  ei.n- 

-ti.ii.i.i,    »  ^..1.11.)..    1..,,  ....     .1.,   *    ;.      , „-,    .,  .;  I    „         1-  1.  .... 

- ■    •■■■    I-.lie.reai.itl   leat!;:;;;.,      ;■ .  .r  .aillk  ,ii    |.iir- 


15 


l)oses,  particularly  the  >tiuly  of  acido.sis,  the  iiK'thoil  of  dialysis  is  (|uite 
as  aiiplicalile  as  tlie  electrdiiietric  method,  aiul  yield',  results  in  rreneral 
coni])araliie  willi  tlm-e  ni  ilial  iiietli(p(l.  It  ha-  the  aihantayes  nf  .siui- 
plieity  and  ra])icHly. 

(■(  iNCI.rSKl.NS 

1.  The  indicator  nuIJKjd  (if  dctcrniinin;,'  Ildun  cnnccntration  is 
ma<le  ap|ilicahle  tn  hhidd  and  -t'rnni  hv  utilization  of  dialysis  throu_i;h 
a  collodion  nienihranc.  \\  hich  exclude'-  the  disturliinf^  influence^  of  color 
and  ol  jirntein-.  The  nictlioil  i>  simple,  accurate,  rapiil  ,and  well 
.id.ipted  Inr  clinical  u~e. 

2.  'The  technic  con-i-I-  <if  diaU/ini,'  .^  c.c.  of  hluod  or  -eruni  ,it 
room  tcpiper.iliu'e  ;is„'.-iiii-t  .i  c.c.  of  OS  jier  cent,  --alt  -olutinn  lor  li\e 
minute,-,  addin;^'  an  indiiator  ,-inil  comparini,'  with  colored  -tand:ird 
phosiihate  mi.\lure-  of  known  ll-inn  coiicenli.-ition. 

.1.  1 'llciiiil-ulplioneplulialein  i-  eniph  i\(.'d  a-  the  indicator  in  this 
method.  ll  i-  lunnd  to  exhihil  ea-il\  di-tini;in-h;ihlc  \.iriatinn-  in 
(|nality  of  culnr,  widi  nnnule  diffevuice-  in  ll-inn  concenlration 
helwcen  the  limit-  pllod  .and  pi  IS. 4. 

4.  (  )\;d,ilcd  lilnnd  from  norm.'d  indi\  i'hi.d-  t;i\e-  a  dial\>ate  with 
•a  pi  1  \.nyinu'  from  ".4  to  7.i<.  while  th.it  ui  -eruni  rani;e-  from 
7.(1  to  7.S. 

.^,  \  .iri.ilicio-  frnm  the-e  liu;ure-  toward  the  :icid  -i.le  were  encoun- 
tered onl\  in  cnnditinn-  which  clinicillv .  .-md  fr^m  the  -tandpoint  of 
the  lalKjr.-nnrv   hndini;-,  e\iilenccd  an  acidn-i-. 

<i.  In  ,1  -ni.dl  -erie-  nf  clinic, il  acidn-e-,  the  -erum-  \aried  from 
7.rr  tci  7  2  anil  llic  uxalated  lilnnd  frnm  7..i  In  7.1.  In  cspirimental 
;ii'idn-i-  in  dn^-,  ,•[  pi  I  nf  i<'>  ha-  liecn  uicnnnlcred  in  Imih  -ennn  .and 
lilond  jn-l  lictni'i-  de.-ilh. 

Kl-  I'l  iKT   I  ll'   (  ASl'S 

Cx-i  i  li  S  (Mt'ilir.il  \..  ,11441  I,  a  ulnt.  hi.lii.  a.ucd  4.!.  Uiagnosis: 
ciir.m  iiil.al  ry-in-  kl.|nc'\ -.  ailluri  lit  |'cru-.'ir4unii,  niMnurilial  iiHiiliicii'iu-y,  t-denia 
of  lungs,  hydrotliuiax,  mikI  iiri'iiiia.     .\ilmitt<  d   Dec.  12,  1^14. 

The  patifiit  had  ^ond  general  liealth  unlil  ten  yuar^  asn.  He  had  nin-ciilar 
rlu'utnatism  at  eight.  I'.ightcon  years  ago  he  liad  an  attack  ni  "acute  Mnght''- 
di-easc,"  uiiich  ounliiied  him  tn  liod  fur  two  ui'd<-.  Ten  year-  agn.  .'i  Uiinp 
uas  discoviTed  in  thi'  I-.ft  tl.iiik.  l-lx|il.iralnry  opfratioi;  revealed  congenital 
cystic  kidneys  .md  .'i  l'<  w  nt  llu  c\-ls  in  the  right  kidney  were  pinictnred.  Five 
years  later  the  left   kidney   aNu  heeanic  palpahle. 

The  prc-ent  illness  began  live  months  hefore  the  patiMit'-  admis-inii.  uith 
attacks  of  noctnnial  dyspnea,  which  f^rnihially  luciiiu'  wnr^f  Thri  r  ui'iks 
ago  swelling  of  the  legs  appeared. 

i'!\aniiiia!ioii  showed  an  iinileriionrished  man.  dyspneie  and  orthnpneic.  Signs 
iif  lliiid  uire  present  in  both  pleural  sacs,  with  biilililing  rales  over  the  lower 
lobes.  Tbt'r-  w.i-  m.irkid  cardia;-  enlargement  and  systolic  retraction  of  inter- 
spaces lateral  In  ,i;i,\  llroadbent's  sign  was  present.  ;»lso  a  protodiastolic 
i^rillnji  I  hero  was  a  f.'iint  -y-;to|io  blow  :it  the  rijiex.  which  was  trattsmitted  to 
the   axiila       Ihc   pnliuonic   second    soniul    w;i-.   accentuated.     The   abdomen   was 


16 


ni-iiii.l>,l   \Mili   lliii^I.      A    laryi    nla-^  >-.vriMl   uiili   b.wsc-   u.i-   palinl.K-   in   each 
llaiik.     Till'   ln(i-   u,,-   iiilarycil   ami   ttiickT,      l-aliriia   nf   Ki;,   v\a-   ii(jUc!. 

Kipi-.iU.I  l>li«i aKulplioiuplillialciii  trsts  vli.intcl  tile  iNrr.li.n  ,,f  only  a  trace 
111   l\V(i  li'iiir>. 

Ill-  I  I  I..  I<ii-i..ii  ,.1  alwnlar  air  \,a-:  Dirmili.r  ICi.  .M  ,1  nini.  lit;;  I  ),crnili(.T 
IN.   I'M   iniiK   llu 

I'll,    ln.li-.iurii  li.'i    (.■'inr(iitrat|..n    .'l    1,1 1    ua^:     Drreinli.  r   -'d.    « Imlv    i,l,„„l, 

7.1  ;   Jamiary   _'.    ~i  i mii,   7.4 

'l"lu-  ncMliu-Mt.ni   iiitr.Mjin  ..f  the  M 1    ua-    11,-^  my.  ]<i-f  hiin^lrnl   cailiio  c.iili- 

iiu-ti-rv     'I'lu'  111 I  pri--iirf  r.iiiycil   iinm  1,-,=^  i,,   \}^  nim.  II"  ---li^lir    llli  t,.  7^ 

.liasl.ilic 

Till'  iirinr  wa-  pak-  ami  cKar  vvitli  ,i  -pioiiic  Kra\ity  oi  l.lins  p.  IdlJ,  A 
trace  I.I  allmniin  and  liyalinr  ca-l-  ueii  dli-crvcil.  .\i-ftnno  was  |iri-int  on 
-oviM-al  oi-ca-innv    'I'lu-  p.iticiit  «as  cliM-hari;,  <l  Jan.  11,  I'll,^.  -..iiiruha!  iin[irovcd. 

Cs.-i  --C.  ()  P.  i.Meilieal  .\.i  .W„?S,^i.  a  ulntr  man  ai;..l  4,1  1  lia..;nosis  ; 
artiri.i-ckToM~.  acnte  and  .-lirnnic  liciibritis  liypcrtensiun  and  nroini.i  .\iliiiitt<d 
Di-c.  1.  1<;14.  TIr'  patient  Iiad  liyplnli-.  twenly  years  a.nn  ,ind  ua^  triati  1  liy 
intermittent  cour-es  of  nit-renry  ut  I'nnr  \ear-  11.  had  nne.implieaied  nplmi.'l 
fever  t«emy-tlirer  year-  an"  and    fr..iii    I'liS  i,.   p  1_'  drank  luaviK, 

The  present  illness  hei.;an  two  year-  as.,  uilli  -,  \  rre  lieadaehe-,  u.Miallv  coni- 
ini,'  on  in  the  early  iiiorninK  hour-  and  heeoiniiiL;  Ljradua!l\  more  severe.  Pnl>nria 
and  nycturia  -oon  f.illnue.l.  Ihrec  month-  .a.i^o  he  had  an  attack  of  -luhkn'  1  .-- 
of  conscionsncss  with  ,i  ueiier.ali/ed  conMiNion  lastin.i;  live  or  -i.\  minute-,  .ind 
folkiwed  hy  prnfn-e  \ ..initin.i;.  Me  was  in  Led  fur  four  day-.  There  ua-  no 
paralv-i-.  laKlit  weeks  hefore  his  a<lmi--ioii  M  ,,1  was  di-co\er<d  in  llie  mine. 
Ill'  w.a-  pnt  to  lied  and  has  remained  there  -in,e.  Iw./  in.inlh-  a.i;,'  his  eye- 
sight  hegan   P,   f.iil  ;   In    i-  imw    iinalile  Im  reail, 

I'.xaminalinii  -hnwed  a  fairl.v  iiomi-lud  m.in  wiili  ii.i-ly  cnmplexion  and 
decidedly  anemic  appearand,  dlie  hea-t  \v,i-  nndn  .itil>  enlarged.  There  was 
a  presystolic  gallop,  with  nmmri.iis  e.\lra-\ -i..U -.  j'hr  -econd  aortic  -oniid  wa- 
loud  and  ringing.  The  radials  anil  brachials  were  dilTiisely  thickened;  th,  -,1111- 
pnrals  tnrtnoiis  and  sclerosed,  .\dvancid  .•iHMimimiric  retiniti-  w.i-  nitnl.  uiili 
fie-h  hemorrhage  in  liotli  eyes. 

The  III. .oil  count  showed  red  iil.i.iil  cell-  .l,-_'i  i.l  1 11 1 ;  while  1.1. ...1  cell-.  11.4(111; 
lu  111.  .uL.liin   (  S;ilili  1   <<5  pir  cent 

l'..\  Ilie  phenol-iilplioiieplithalein  te-t,  e\creti.,ii  111  |«..  |i,.iir-  ..n  iiiinier..ns 
occasions  ranged  fri.m  a  trac.  to  16  per  cut.  Dec.  inker  ^.  llu  iiali.iii  was 
V. uniting  and  helchiiig  a'    frei|r,.iil   interval-  aii.l   wa-   \ei-.\    .lr..w-v. 

.Sellard'-  test  on  the  I1I0...I  -eniiii  -h..we.|  c.ini|ilete  decilori/ati.ni  .111  e\ap..ir- 
i/;iii..ii;   111.  c.ilor  on  ad.Iitioii   ..f   w;itir 

111.  h.Mlrogeii-ion  conceiilratiiin  of  the  sermii  w;i-  7. J.  1  iiiriiii;  the  patient's 
-ta\  111  the  ho-pital  the  likiod  pressure  ranged  fn.m  Jd.^  t..  174  -v-t..lic;  I,i6  to 
lii,'^  .li:i-t..lic. 

11.1  tirine  in  fpi:mtity  wa-  l,!L'.s  1..  .-.{L',s  cc  m  tw  riii\ -f,,nr  li,.m-;  its  spe- 
cific gravity,  l.l'll.s  t..  I.IIO''.  Siimk;,  :it  lir-1,  it  lucinie  cl.ar  Willi  th.'  polyuria, 
then  hlo.idy  again.  l-'rom  2  to  .s  gr;iin-  ..f  .allniniin  p.  r  liter  wi.e  pre-cnt. 
Ihaline,  granular  and  Mood  casts  were  ohservcl.  The  ,)alum  rrf  .-ed  tr. 
remain    for   treatment   .iiid    ua-   di-charged   tinimprov.  .1,    1  )ec,    .'_'.    I'd4. 

C.\si  .1.-1  W  ( (  thstetncal  Service),  a  colored  girl,  aged  l!^.  was  admitted 
Jan.  8,  I'l.r  I  )i;iaii..sis ;  pre-edamptic  toxemia;  po-tpartiim  eclampsia,  d'he 
girl  was  nine  month-  pregnant.  On  the  day  hefore  adnii--ii.n,  :dl.iimin  an.l 
casts  were  found  in  the  urine,  and  the  patient  wa-  a.Ki-.d  to  enter  th.'  ho-pilal. 
I)uring  the  cottr-e  of  the  next  few  days  she  ci.nipl,iii-..il  .if  epigastric  di.scom- 
f.rt  ami  frontal  headaches  of  increa-iiig  severity  111.'  ->-t..lic  hlood  pressure 
w,i-   I'd  mm.   Ilg.     ^>u  January   12,  -light  edema  of  the  leg-  ,ipp.;ir.  .1 

I'll  January  ]^.  at  7;.i.^  a.  in„  spontanenus  lakor  occurre.l  Ten  minutes  .ifter 
the  hirili  ..f  tbv  •Jidi!  the  palienl  !lad  a  l.^p;cal  eclamptic  convulsinn  of  mo. k  late 


^i'\i'nl>  lii-tiim  luii  niiii'.iir-  llic  i. III. Ill  |irr--iiri'  i-wtnlii'l  ,'it  tin-  linn'  ua-  15(1 
mm.  lly.  Tlu'ri-  ucri'  lun  niurr  i-i.iivr.l-inn-  that  ila>.  i^'nllnw  mi;  lilrciliiit;, 
piiriuiinK  ami   '•weatiiiL;.  a  iininial   iinnali -iiiur  iii-iuil. 

'I'lic   li'.ilriiyrii-ii.ii   i-nm-ctitratinii   nf   tile    -mmi    I'litaimil    at    vvnt-i\'tiiiii   was 


Tlir  111  ii^iii-iitrm   iiiiriium    iii   llir   Mi  ml  ua-  4_'  iim    pir    Inil  i-.c. 
.I.MUiar>    -'4.   llir   iihrri'l-iilnliiii!r|iliilialiiii    ir-t    -linucil   53    per    cent,   c  \rriti.iii 
iti   tun   Iniir-. 

Tlir    .mitiiiiiia   iiitrii^rn    m   ihi.-   iiriiu' : 

January    H  ;=  5   per  i-int 

January   14   =  ')  \n-r  it  iit 

Jaiuiar\    Id  =  7  [u-r  n  ii; 

C\si  4--.M,  K.  I  (  ll.-trtrir.'il  SirviiTi.  a  uliitr  unman,  a(.;ril  I'',  ua-  ai!milt.:il 
jjii    J.-i.    1"I.^.      I  liai;iii  1-1- :   (■i!am]i>ia  ;    -pi  mtaiu  mi^   lalmr. 

I  111-  paluiit  ua-  a  -irmiu.  ucll-ia  mn-luil  pvmiipara,  niiir  niiiilli-  prr.miant. 
'i'lu-  pi'iiinaiicy  hail  !naii  iii:r\  laitfiil  nnlil  llir  mnrniiiK  ol'  Janiiar\  J5,  ulirii. 
at  4  a.  m,,  slu-  lnuan  tn  havr  -iaiit  hrailarlir.  naii>-ca  and  M.imtmt;  Shnitly 
al'li  I'uarij  -lu'  hail  nni-  emu  iilsimi.  \\  In  n  M'cn  in  thf  out-patiint  -i  i\  kc  -Ik 
ua-  i-iiii-i-iii;i-  lar,  ilmu-y.  Hhiml  piT--urr  (-y-tdlic)  was  150  inn.  lit;;  tlii- 
pul-r  Sll   pir   miniiti'       Tlu'   iiriiu'   -linunl   S  grains   nt   alliiimiii   pc-r   liter. 

Slu-  ua-  ailnnttt-il  tn  llir  uaril  .at  7  \i.  m.  mu-nii-cinn-.  i-\i\ailinuly  rr-tlc--, 
anil  haMiiLi  tNpiral.  nimU-rairly  -r\,-rr  i-clainptic  onnviiKiuiis  at  intir\al-  nl" 
ihrri'-qnarli  r-  nl"  :iii  Imn;-,  Tlu-  hlnnd  pia'--nrr  ( .■ivstolic')  was  ISH  mm.  lit: 
Tlu-ia-  u.a-  iin  il^-pma  ami  \aT\  -liijh!  i-ilcma  nf  Inui-r  U-i;-  Slu-  had  ^c\rn 
i-ninin-iiiii-  in  all.  tlu-  l.a-t  niauirraii;  at  5  a.  in.  mi  the  ninrniiu;  ■•>  Jaimarv  J'l. 
illnnd  Iiir  lljiiromT.  mn  dctt-rminatinn.  nlitaim-d  ,iMrr  tlu-  third  d  iiiMil-mn.  t;,a\c 
a  rt-aclini;  uf  7.5  on  ibc  scrum;   7  .'•  nii  tin    ulinK    hi I 

l-V-IIouinR  vciK-cctidii.  pnriiatinii  and  -uintinj.  and  tlu-  ,-idniiiii-tratiiin  nf 
41)  ^ram-  of  fo<litim  hicarhmiati  li\  -tni.i.-udi-tiilK-.  tlir  i'iin\  iil-mns  lii-allv  r<a-nl 
.•imi  ■■nn.icii'iisiu -s  rcliirned  mi  tin-  ninniiiiK  nt  Jann.arx  Jii  (  )ii  Jamian,  JS  a 
lUad    child    wa-    Imni    -puniaiu  mi-ly.      'I'lu'    piu  rpi-riinii    \\,i-    nM-\  i-ntlnl. 

riu-  amnim-ia  ritri-mii  --■■  -.iriiu-  dnriiu.;  llir  tlirn-  d.n  -  |ua-oi-i|iii-.;  iU!nar_v 

r.iiu^ti',   trnin   1,'<  !n  Id  pn- 

Janii.ar>   2'i.  tlu-  liMlrni;i-i  ci  nu'riitratimi  nl   lilnnd  u.-i-   fur  tin-  svriim.  7  S  ; 

fnr    ilu-    Uhnh-    hlnnd.    7.5- 

Casi.  5.  I..  ('  (ll.-irrii-t  Lane  ll'inu-  \n.  ii.5.'Si.  .i  ulme  l.ny.  a:;od  ^.  ua- 
admittc-d  Jan    l.l  i'  15.     Diagridsis:  .sarcmiM  nf  ilu   kidiu  >  anil  aiitrnni ;  .-u-idn^i- 

Thr  l:n\  had  lu-cii  .'i  nnrin.-il.  hoalthy  I'hild  up  tn  ilim-  mmirhs  lutnrc  admi^ 
-inp.  ulii-n.  fnlliiu  ini,'  .'i  trauma  tn  tlu-  lai'i .  a  -m  ''  ml  -urlliiu;  appt-.-ircd  mi 
the  li-ll  clu-ck,  suh>(.-ipU'ntl>  pii-him;  tlirmmh  In  ih,  -nf  nf  tlu-  iiimith.  ■riimii.ih 
painless,  this  swcllint;  had  i;railiiall>    ymun  lar.ci-r. 

l-'.xaiiiinalioii  shnui-d  a  ucll-i'i-vi  Inpi  d.  will  rmtri-hid  rhild  Tlu-ri.  ua>  a 
firm  ma--  in  tne  U-fi  clu-rh.  apparently  ari-ini;  m  th.-  antrnm.  and  pii-hiiit;  dnun 
the  left  .side  of  tile  h.ard  [lalate  in  the  mouth.  There  ua^  a  nmiular.  'irni  nia-s, 
the  size  of  a  man's  t'ist.  in  the  risht  nmhilieal  reHimi. 

January   16:     Breat'rni;   w.is   rapid   ami   deep. 

Ja-iuar\  17;  There  u:i-  niirked  dy-piiea;  the  re-pir:ilimi-  ueri  4l)  per 
minute 

January  IS;  Uespiratim;-  nnK-ii:ill\  d<ep.  uitli  ;irtii:il  "ini-  liniim  r."  The 
uritie  ciiiitaineil   aeelr-n'-  and   duueiii-   aeul. 

Sellat'd-'  te-t  -linuiil  cnlnrli--  mi  rnni|ileie  e\apnratinii  Tlu-  liydn  lieii-ion 
oonceiitral  nil  ni  the  sc  rnm  u.is  7  2.  (  Ine  hundred  and  -i-\  eiit\ -ii; a-  e  e.  of  a 
?  per  cent,  sulutum  of  sodium  hicarlmnate  was  given  hy  the  .Murphy  methnd 
Till-  was  followed  hy  175  c  c.  of  a  4  ]ier  cent,  solution  nf  -ndinm  hicadimiate 
iiitr;n  eiuui-ly  Alter  the  lir^t  5ll  c  c.  r<'spirations  heeame  nmieeahly  le-'^  Iiliored. 
.ii'il   -linrtly   .litrr  the  cninpletimi   nf  the   injeeti(iu   the  child   was  f|uite  ci  mfori- 

.,1.1,.  s;,„.i11     ,1,,-..;     .,.•     l,;.-,rl.,.i,-it,.     >.r.r..     r,  ,nf  I  ■ .  .>,  ,1     l.t       „>.,., tli 


IS 


19: 


Scllanl-'    ti-t    shout'd 


a    faint    jiink    iclur    luforo    coiiijik'te 
4?        I  Ik-    child    un^ 


.laiuiarv 
(.■vaporatiirii. 

Tllc    liyclrciiini-ion    cunrrmratinii    of    tlu     '(rum    was 
liroatliiiii;  nuriiially,  tlioiigh   im'iitally   rallur   ilitll. 

During  ill''  siiccccdiiii;  weeks  several  radiiiiii  treatment-  ueie  administered 
and  i;  was  Iiclioved  lliat  the  abdominal  nia<s  had  grown  somewhat  smaller. 

On  I'eliriiary  1>*  the  respirations  became  suddenly  deep  and  niii~y.  The  chilil 
seemed  drowsy.  The  nrinc  showed  a  trace  nl  acetone,  Imt  no  diaeetic  acid. 
The  patient  «as  Kiven  alkali  by  nioiitli, 

rile  li>ilr('nen-ion  concentration  oi  the  sernin   was  7.,V 

Ijn  lebruary  25  the  patient  was  discharged,  lircathiii'.;  auain  wi-  iinrmal 
though  the  general  condition   was  tailing. 

Cn.sk  6. — .\.  McK.  (Harriet  Lane  Home),  a  uliui  l)n\.  ,ii;ed  (>,  \\a-  admitied 
.1.111.  Jl.  I'd.^.     Diagnosis:  recnrreni  vomiting. 

The  boy  had  been  a  normal  child  except  that  hv  li:i.l  ;du,i\>  luid  ;i  "ueak 
stoniacii."  Three  days  before  a<lmis.:,ion.  following  :in  imliscretion  m  iliet.  he 
coniplaineil  of  abdominal  pain.  Next  (lay  he  began  to  \.imit  :i]id  since  then 
had  not  retained  any  food  except  a  little  orange  juice.  IK  ^united  without 
any  apparent  etTort.  and  after  vomiting  seemed  tiuite  well. 

liximination  showed  a  -sparely  nourished  chibl.  apparent!)  ipiitc  i^riiKiI  in 
all  res])ects.  The  urine  contained  acetone  and  <liacetic  acid.  I  lie  In  dniyeii-iou 
concentration  of  the  blood  scrum  wa-  7  5.  I'ollowing  a  «ell-M  gulated  dieiary 
regimen,  he  rapidly  improved  ami   wuit  hinie 

C.vsi;  7.— \'.  D.  (  Harriet  Lane  Home  \'o.  6,028).  a  white  girl,  aged  2  months. 
was  admitted  Jan.  22,  1915;  du  i  Jan.  2,^,  I'llS.  Diagnosis:  alimentary  intoxica- 
tion. 

The  patiiiit  wa'-  a  fnll-lerm.  apparently  he.ahny.  child.  Sixteen  days  before 
admission  she  began  to  vomit  after  every  feeding  and  had  frequent  green  stools. 
The  vomiting  and  diarrhea  persisted  up  to  the  time  she  was  brought  to  the 
ho-pital. 

F.xaniin:ilion  showed  a  -ni:dl.  moderately  well  iioiii  i-lud  baby,  conscious  and 
crying  fretfully.  Slight  cy:inosis  was  |ire-ent  I  he  n  spirjiiory  r:itr  w;is 
increased,  the  rc-liiratmn^  being  full  ancl  deep  White  bbiod  crll-,  2J.ir(i  The 
stool,  large,  green  and   watery,  contained  nuicns  and   food   rc-idtii. 

Scllards'  test  showed  no  color  on  evaporation  or  on  addition  of  di-tilled 
water  after  evaporation. 

The  hydrogen-ion  concentration  of  the  serum  was  ".4. 

Intensive  alkali  therapy  was  given,  both  intravonou>l>  and  >iibctUaneonsly. 
The  respirations  nuproved  a  little,  b.ccoming  sh.-dlower,  Tlun  wa-  one  slight 
convulsion  and  con-tant  convulsive  twitchings  of  the   f.icc  and   extremities. 

The  Iiydrogcn  concentration  of  the  -eriiiu  .after  inti:i\enous  injections  of 
sodiiun  bicarbonate   was  755. 

The  respirations  gradually  became  shallower  and  more  infrcfjucnt  and  the 
baby  died  at  4:55  a.  m.  on  January  23  There  ua-  complete  anuria  during  the 
stay  in  the  hospital.  Partial  necropsy  showe<l  only  enlargement  of  the  iue>eii- 
tcric  lymph  nodes. 

Casf.  S — M  1".  I  Medical  Service),  a  white  man.  ageil  211.  was  admitted 
Jan.  7.  1915.  Dia;jno-i>:  acute  and  chronic  luphritis,  hvperlension.  and  myo- 
cardial insntTicicncy. 

The  patient  had  frequent  sore  tliroats.  Eighteen  months  ago  he  began  to 
have  morning  headaches.  For  three  months,  dyspnea  on  exertion  was  noted, 
beconiiug  progre-sively  more  marked.  Six  days  before  admission  the  feet  and 
ankles  began  to  swell,  and  the  abdomen  and  face  lia\e  -irce  become  edematous. 
Anorexia,  dizzy  spells  and   cpistaxis  have  occurred  during  the  past   week. 

Hxamination  showed  an  ovcrnonrished  young  man,  dy.spneic,  sallow  and 
pale.  Marked  oral  sepsis  was  present;  the  tonsils  were  large  and  ragged. 
Crepitant  rfile-  were  heard  at  the  left  base.     The  heart  was  marked.Iy  enlargei! 


10 


Tlic  liver  was  enlarged  aiul  tender. 
There    was   a   moderate   secondary 


01   i-xcrt-tion  in  two 
7,4,     Tlic-  nonprotein 


There  \vn^  a  -nappiiiR  aortic  secoml  .~ounil. 
Edeina  ot  I'ect  and  aiil<le>  was  pn  sent, 
anemia. 

The   W'asserni.mn   tc -t   wn--   neuativi 

The  phenolsnlphoneiihlhulein  test  showed  55  per  cent 
honr*.  The  hydrogen-ion  concentration  of  the  sernin  wa> 
nitrogen  of  the  blood  was  3()  mg.  per   IIXI  c.c. 

Jann;ir\  Ji':  The  hwlroyen-ion  concentration  of  the  scrnm  was  ".6:  whole 
blood,  7.5.     '1  he  C<-1..  tension  of  alveolar  air  was  40.1   nini.  Hg, 

The  uinif  ii;  i|"'in'i'y  uas  1,500  to  2.000  c.c.  in  twcnty-fonr  honrs.  The 
specitic  gravity  w.is  l.ulJ  to  1,013.  There  were  1.5  to  2.75  grams  of  albnmin 
per  liter.  On  admission,  red  blood  cells  and  acetone  were  observed,  which  subse- 
qnently  disappeared.     N'nmerons  granular  casts  were  foimd. 

The  Iilood  pressure  rangeil  from  170  to  1,311  nmi.  Hg  systolic;  110  to  65  dias- 
tolic.    The  patient  is  somewhat   improved,     lie  i^   still   in  the  hospital   I.April, 


